Guevara-Alvarez Alberto, Valencia-Ramon Edwin A, Bothorel Hugo, Collin Philippe, Zbinden Jeanni, Guizzi Alberto, Lädermann Alexandre
Instituto de Hombro IDH, Hospital Angeles Querétaro, Querétaro, México.
Research Department, La Tour Hospital, Meyrin, Switzerland.
Arthrosc Sports Med Rehabil. 2024 Feb 13;6(2):100867. doi: 10.1016/j.asmr.2023.100867. eCollection 2024 Apr.
To examine whether traumatic rotator cuff repairs (RCRs) differ in postoperative rotator cuff tendon integrity and functional outcomes from degenerative RCRs.
RCRs performed by a single surgeon were retrospectively identified. The inclusion criteria were repairable Goutallier grades 0 to 2 full-thickness rotator cuff tears. Demographic and clinical data as well as radiological results were compared. A multivariate logistic regression of the of patient acceptable symptom state for American Shoulder and Elbow Surgeons (ASES) score was performed to evaluate whether the origin of tear led to a different relative risk (RR) independently from tear and surgical characteristics.
A total of 616 consecutive shoulders (304 traumatic and 312 degenerative) were finally included. Traumatic ruptures presented a greater distribution of male (72% vs 51%, < .001) and younger patients (53 vs 57 years, < .001), as well as earlier onset of symptoms (3 vs 15 months, < .001), reduced range of motion in preoperative assessment for forward elevation (130° vs 150°, < .001), and slightly greater preoperative ASES (46.5 ± 19.7 vs 50.0 ± 18.0, = .022) and Constant (47.0 ± 20.2 vs 52.0 ± 18.9, = .001) scores. Degenerative tears presented a lower proportion of grade 3 tendon coronal retraction (11% vs 18%, = .031). Postoperative tendon integrity at 6 months was comparable for both groups, predominantly Sugaya types 1 and 2 (91% traumatic; 92% degenerative, = .371). Both groups exhibited favorable outcomes in range of motion and postoperative functional scores at last follow-up. The multivariate regression confirmed that the tear origin was not significantly associated with patient acceptable symptom state achievement ( = .201) but rather with greater preoperative ASES score (RR, 1.01), men (RR, 1.16) and workers' compensation (RR, 0.65) ( < .05).
Traumatic cases were frequent, involved younger patients, more frequently affected the anterior rotator cuff, and were associated with more severe tendon retraction. Traumatic and degenerative RCRs lead to comparable clinical and radiologic results.
Level III, retrospective comparative study.
探讨创伤性肩袖修复术（RCR）与退行性RCR在术后肩袖肌腱完整性和功能结局方面是否存在差异。
回顾性确定由单一外科医生实施的RCR。纳入标准为可修复的Goutallier 0至2级全层肩袖撕裂。比较人口统计学和临床数据以及影像学结果。对美国肩肘外科医师学会（ASES）评分的患者可接受症状状态进行多因素逻辑回归分析，以评估撕裂的起源是否独立于撕裂和手术特征导致不同的相对风险（RR）。
最终纳入616例连续的肩部病例（304例创伤性和312例退行性）。创伤性撕裂在男性患者（72%对51%，P <.001）和年轻患者（53岁对57岁，P <.001）中的分布更多，症状出现更早（3个月对15个月，P <.001），术前前屈活动度评估中活动范围减小（130°对150°，P <.001），术前ASES评分略高（46.5±19.7对50.0±18.0，P =.022）和Constant评分略高（47.0±20.2对52.0±18.9，P =.001）。退行性撕裂中3级肌腱冠状面回缩的比例较低（11%对18%，P =.031）。两组术后6个月时肌腱完整性相当，主要为Sugaya 1型和2型（创伤性91%；退行性92%，P =.371）。两组在末次随访时的活动范围和术后功能评分方面均显示出良好的结局。多因素回归证实，撕裂起源与患者可接受症状状态的达成无显著相关性（P =.201），但与术前较高的ASES评分（RR，1.01）、男性（RR，1.16）和工伤赔偿（RR，0.65）相关（P <.05）。
创伤性病例较为常见，涉及年轻患者，更常累及肩袖前部，且与更严重的肌腱回缩相关。创伤性和退行性RCR导致相似的临床和影像学结果。
III级，回顾性比较研究。
